Tuesday, July 27, 2010

Sp.erm DNA fragmentation: what's next

For Q&A #2
Mrs. Katia asked: I'm wondering, though, if you ever re-checked Mr. Hammer's sperm fragmentation after a few months on the supplements? We might have the same problem here, and my husband is on pretty much the same stuff! I was excited to see that. However, we aren't going to send in his sperm before trying again. I'm just curious if you know there was a difference in the dna integrity or if you're hoping like we are. Thanks!

Excellent question and one we’ve been debating about for a few months now. Prior to our cancelled IVF cycle #3 we were set on not checking. The reason was because the decision would not change if we were doing IVF or not. But now that we’ve had a chemical pregnancy via IVF to IUI conversion we’ve become more curious about whether all these supplements have been effective. We’ve never had ANYTHING happen with our 5 other IUI’s. And we have time to get it checked prior to IVF #4. Being faced with the very real possibility that IVF will not work for us has made us wonder now, with supplementation, if we could ever get pregnant on our own. And the chemical pregnancy has given us some hope – crazy huh? Will that stop us from IVF #4? Nope. But if we have to move on to adoption it’s not like we’re going to stop trying on our own. The question then comes, do we stop the supplements? If they work, then the answer is no. But how will we know if we haven’t tested! And that is why we are now thinking it might be worth another check. Plus we’re currently on my insurance which will pay for 60% of the cost. Not too shabby when you consider that almost everything else is out of pocket.

So it’s very possible that in August we might be retesting Hammer’s DNA fragmentation. For those of you reading that are thinking, “What on earth is she talking about?” Don’t feel in the dark! This is a very rarely tested sperm analysis. We only got it tested because we kept getting gorgeous day three embryos to transfer that would end up in BFN or miscarriage. Typically the egg DNA drives the first three days of cell division, after that the sperm DNA kicks in and if it’s no good then there is no baby. Here is an excerpt from an article in RESOLVE about SCSA (the DNA test):

  • "Sperm DNA fragmentation has little or nothing to do with the parameters that we measure on the routine semen analysis. It has little to do with the shape of the sperm or whether the sperm are moving. It is a completely independent variable. Men with otherwise normal semen analyses can have a high degree of DNA damage and men with what was called very poor sperm quality can have very little DNA damage. More importantly what has also been demonstrated is that the degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate a birth regardless of the technology used to fertilize the egg such as insemination, IVF or ICSI. Sperm with high DNA fragmentation may fertilize an egg and embryo development stops before implantation or may even initiate a pregnancy but there is a significantly higher likelihood that it will result in miscarriage. By testing for sperm DNA fragmentation, many cases of formally “unexplained” infertility can now be explained. Many of those couples who have been previously unable to conceive with what would be considered extreme measures have been diagnosed with high sperm DNA fragmentation and treated. It is now very clear to see that having this information about the quality of the sperm can be tremendously helpful to couples and their physicians."

Hammer’s family has a history of infertility on his father’s side so when everything looked good but left us empty handed we pushed for this test and TAH-DA! 48% fragmentation, which is really, really bad.

<15% normal
15-30% good to fair = IUI or IVF for higher % in the range
>30% poor = IVF w/ICSI

If you want to read more about it, Conceive This!, wrote a really great post about it. And then there is also this website where I took the excerpt from, that provides another explanation.

So what causes it?
  • "The causes of high DNA fragmentation are those same causes of male factor infertility that we have known about for years such as chemical/toxin exposure, heat exposure, varicocele, infection, age, smoking, testicular cancer, radiation, and anything that increases the free radical levels in the semen among a list of many other things. It is very important to understand that sperm DNA fragmentation can change with time and it can be improved in many cases. The goal of a male factor evaluation is to seek out the causes of poor sperm quality and try to correct them so conception can occur naturally or to improve the sperm quality for IVF and maximize the chances of success."
How we have been treating the problem: (Hammer’s Supplements)

-Vitamin C 1000 mg (500 mg morning and evening)
-Vitamin E 800 IU (400 IU morning and evening)
-L Acetyl-Carnitine 1 gram
-L Carnitine 1 gram (morning and evening)
-Pycnogenol 100 mg
-Co Q-10 75 mg
-Centrum’s One-a-Day Men’s Health

In addition to vitamins we are both drinking antioxidant smoothies:

1 oz acai juice
1 oz pomegranate juice
1 oz frozen wheat grass
½ cup organic blueberries
½ cup organic orange and/or pineapple juice
½ cup organic yogurt
2 tbsp raw honey

I will say that, for myself, after 6 months of drinking these smoothies, plus a multivitamin and 100 mg Pycnogenol I went from having questionable antral follicles on my left ovary to having excellent numbers on both sides with my left better than my right! So if it worked for me I really hope it worked for Hammer.

*As before if you have any other questions for me just leave them in the comments and I will do a post about them.


kdactyl said...

I am loving the Q&A...oh how I wish I would have known about sperm DNA fragmentation a few years ago when we were first starting this. My DH was in the airforce for 8 years and spent a lot of time around the airplanes with the nuclear missles and such in them...his exposure to radiation was more than the average joe and we always assumed that had something to do with his problems. We were lucky that IVF with ICSI worked for us....but like you...our IUI's were a bust and I had like TONS of follicles...we could have been octomom but took our chances...and only one time (when I had 14 mature follicles) did we get pregnant..with identcle twins...but we lost them to an early miscarriage at 9 weeks. This is awesome info....I am with you...I think running the test agan is a good idea. Knowledge is power you know.

Hillary said...

Very interesting info. Maybe this is why our embryos are pretty good until day 3 when we transfer them, but I'm not ending up pregnant. But I guess doing the test wouldn't really change anything for us (we would still do IVF w/ ICSI), and my DH already did a vitamin cocktail for awhile...I'm not sure I could get him to do it again...

I think I will ask the RE about it, though.

But in your case it sounds really smart to run the test again, and I hope you see big improvements!


Mrs. Katia said...

Thanks so much for your thorough response! I think you’re right in suspecting that the antioxidant treatment has been positive for Hammer’s sperm. A chemical pregnancy through IUI is a big step. I’m really glad to hear that you’re re-testing in August. Because the idea of fragmentation is so new and treatment is not standard or well studied, every test result and every couple’s story provides a piece of the puzzle.

I had two blighted ova in the past year after my husband had just gotten off a 5-year stint of antidepressants, which are closely linked with high sperm dna fragmentation. (Note that while on the medication, we never got a BFP.) After three months of virtually the same cocktail Hammer took, we tried again about 2 weeks ago but got a BFN. The question for us (like you) is whether to do the SCSA before trying again. I’d like to know the percentage, even though I don’t have a past number to compare it to. The problem is that it’s so hard to find a doctor under his insurance that will do the SCSA before doing a whole lot of other tests ($!), much less a doctor who even acknowledges that antidepressants cause dna damage! Ugh! Often I feel alone here in trying to figure all this out, so I’m thankful for your updates and for all other bloggers that I’ve come across.

I’ll continue to follow your story and pray for great results in your next IVF round! Thanks for everything.


PS We were making antioxidant smoothies too — funny how we were doing so many of the same things!

Grace said...

It sure does sound like a great idea to have the test done...you never know until you check..

How're you doing?